Organization
OPTIMAL PERFORMANCE HEALTH CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COREY VAN WESTEN D.C. (OWNER/CLINIC DIRECTOR)
(414) 491-8650
Entity
Organization
Contact information
Practice address
10500 W LOOMIS RD, SUITE 160, FRANKLIN, WI 53132-8030
(414) 491-8650
(414) 810-0894
Mailing address
1962 N COMMERCE ST, MILWAUKEE, WI 53212-3401
(414) 491-8650
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
4410-12
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002627
—
WI
01
—
1275814345
GROUP NPI
WI
01
—
1588628473
INDIVIDUAL NPI
WI
Enumeration date
09/02/2011
Last updated
09/23/2011
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